Division of Internal Medicine, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy.
World J Gastroenterol. 2012 Aug 7;18(29):3800-5. doi: 10.3748/wjg.v18.i29.3800.
Inflammatory bowel diseases (IBDs) are characterized by a chronic course with an alternation of relapses and remissions. Questions about prognosis are important for the patient who wants to know how the disease will affect his/her life and also for clinicians to make management decisions. Correct selection of the patients is the basis for good methodological studies on the course of IBD. A great proportion of data on the course of IBD is derived from a limited number of cohort studies. Studies help to define the endpoints for clinical trials and to identify subsets of patients in whom the prognosis of the disease can be stratified according to clinical features. Specific scientific requirements for high-quality studies on prognosis are the following: use of inception cohort, description of referral patterns, completeness of follow-up, objective outcome criteria, blind outcome assessment, adjustment for extraneous prognostic factors and statistical issues. We analyzed each of these requirements in studies on IBDs. To date, prospective and population-based cohort studies are the standard for an unbiased assessment of prognosis. A better knowledge of the course of disease of chronic disorders ideally requires: (1) data from population-based studies, to avoid selection bias from referral centers in which patients with a more severe disease are usually treated; (2) inclusion of patients seen at the onset of the disease excluding misdiagnosed cases; and (3) follow-up from the onset of the disease to the end without dropouts.
炎症性肠病（IBD）的特征是慢性病程，伴有缓解和复发的交替。预后问题对于希望了解疾病如何影响其生活的患者以及临床医生做出管理决策都很重要。正确选择患者是 IBD 病程良好方法学研究的基础。很大一部分 IBD 病程数据来自少数队列研究。这些研究有助于确定临床试验的终点，并根据临床特征对疾病预后进行分层，以确定患者亚组。预后高质量研究的具体科学要求如下：使用起始队列、描述转诊模式、随访的完整性、客观的结局标准、盲法结局评估、调整混杂预后因素和统计问题。我们在 IBD 研究中分析了这些要求中的每一个。迄今为止，前瞻性和基于人群的队列研究是对预后进行无偏评估的标准。要更好地了解慢性疾病的病程，理想情况下需要：（1）来自基于人群的研究的数据，以避免来自转诊中心的选择偏倚，因为通常在这些中心治疗更严重的疾病患者；（2）纳入疾病发病时的患者，排除误诊病例；（3）从疾病发病开始进行随访，直至终点，中途无脱落。
